[Thrombosed anastomotic aneurysm of the vena saphena parva].
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Biomedical subjects
Publications and source records attributed to E Rabe.
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With color-duplexsonography the simultaneous visualisation of the vessel anatomy, the flow and reflux in insufficient perforating veins, and the corresponding superficial and deep veins is possible. Insufficient perforating veins may have different pathogenetic reasons. We differentiate three groups of insufficient perforating veins (IPV). The different kinds of insufficient perforating veins require different therapeutical consequences.
A differentiated surgical treatment of primary varicosis of the long and short saphenous veins, according to the type of varicosis, is necessary to avoid significant recurrence. The cosmetic results must also be taken into consideration. Knowing the most frequent types of primary varicosis and the principles of selective surgical treatment, the surgeon is able to perform a curative operation with a low complication rate and level of postoperative morbidity, high compliance, and excellent cosmetic results.
Percutaneous Minisurgical Phlebectomy is a safe and effective form of permanent treatment for side-branch varicosis in addition to other varicose veins (except the proximal part of the long saphenous vein) by means of multiple 1 to 2 mm incisions. The operation is performed using local anaesthesia in the outpatient department. There is no need for prophylaxis against thrombosis. Complications are rare and inconsequential.
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20 patients (i.e. 40 lower extremities) with chronic venous insufficiency were examined by means of colour-coded Doppler sonography (CCDS). This method enables the simultaneous visualisation of the anatomy and haemodynamics of the examined vessels. All cases of varicosis of the stem of the vena saphena magna (VSM) (n = 21) and of the vena saphena parva (VSP) (n = 13) were correctly diagnosed by CCDS. However, an incomplete varicosis of the stem was identified in only 3 of 5 cases. Insufficiency of the V. perforantes was identified by CCDS with a high rate of accuracy in diagnosing the insufficiency of the cross of the VSM and VSP. Although assessment of the V. perforantes and diagnosis of incomplete stem varicoses or varicoses of lateral branches is possible, as a rule, it does take up much time and requires a great deal of experience on the part of the investigator.
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Venous aneurysms are rarely mentioned in the literature. Regarding those in the foot region, only 4 cases have been published so far. We report on the clinical and diagnostic features of 2 young women showing venous aneurysms in the first part of the long saphenous vein on the right back of the foot. In both cases, sclerotherapy was successfully performed.
Varicectomy is a particularly useful procedure in the surgical treatment of varicose branch veins and perforating veins, since it allows selective estirpation without affecting the main trunk of the long saphenous vein (LSV). At the same time, there is usually no need of further sclerotherapy. The operation can be performed under local anaesthesia in the outpatient's department or, if a saphenofemoral junction insufficiency has to be simultaneously removed, during a short stay in hospital. The aesthetic results are remarkable. With the help of the new delicate instruments devised by Varady, the incisions are very small, making sutures unnecessary. All the varicose veins can be removed at once, there is no loss of blood and no need for prophylaxis against thrombosis and the postoperative ecchymosis is minimal. Thus the method can also be applied in elderly patients.
The accumulation of arginine in leaves of four citrus rootstock cultivars during P deficiency has been demonstrated to be due to increased de novo synthesis rather than decreased catabolism or increased protein degradation (E Rabe, CJ Lovatt, 1984, Plant Physiol 76: 747-752). In this report, we provide evidence (a) that the increased activity of the arginine biosynthetic pathway observed for citrus rootstocks grown under P-deficient conditions for 7 months is due to an increase in the concentration of ammonia in leaves of P-deficient plants and (b) that ammonia accumulation and removal through arginine systhesis are early responses to phosphorus deficiency for both a woody perennial, rough lemon (Citrus limon), and an herbaceous annual, summer squash (Cucurbita pepo). Transferring 5-day-old squash plants to a phosphorus-deficient nutrient solution for only 10 days resulted in a 2-fold increase in the concentration of nitrate in the youngest fully expanded leaves (YFE). Concomitantly, the specific activity of nitrate reductase doubled and the ammonia content of P-deficient YFE leaves increased to a concentration significantly greater that of leaves from healthy control plants (P < 0.05). Consistent with increased availability of ammonia, the incorporation of NaH(14)CO(3) into arginine plus urea doubled during phosphorus deficiency and arginine accumulated. Despite the accumulation of nitrate and ammonia in YFE leaves during phosphorus deficiency, the total nitrogen content of these leaves was less than that of the healthy control plants. Similar results were obtained for rough lemon. Nitrate content of the YFE leaves increased 1.5- and 3.0-fold in plants deprived of phosphorus for 6 and 12 weeks, respectively. Ammonia content of the leaves increased as P deficiency progressed to 1.4 +/- 0.08 mg (+/- se, n = 4) per gram dry weight, a level 1.8-fold greater than that of the P-sufficient control plants. During P deficiency de novo arginine biosynthesis in rough lemon increased 10-fold. Immersing the petiole of YFE leaves from P-sufficient squash and rough lemon plants in 50 millimolar NH(4) (+) for 3 hours resulted in the accumulation of ammonia in the leaves, and a 4-fold increase in the incorporation of NaH(14)CO(3) into arginine plus urea. Taken together, these results provide strong evidence that the accumulation of nitrate and ammonia in leaves is an early response of both woody and herbaceous plants to P deprivation. The data are consistent with the hypothesis that increased de novo arginine biosynthesis in leaves during P deficiency is in response to ammonia content of the leaves.
Twelve children with malignant disease in whom there was either a clinical, radiologic, or histologic differential diagnosis including neuroblastoma were investigated using iodine-131 metaiodobenzylguanidine (MIBG) scanning. In six children in whom a final diagnosis of neuroblastoma was substantiated, scans were positive; in five children with other malignancies, scans were negative. In one child, clinically and radiologically tumor free following excision on an abdominal neuroblastoma, scans were also negative. MIBG scanning proved of value as a discriminant of malignant undifferentiated tumors in children, and in the diagnosis and staging of neuroblastoma. During treatment, MIBG scans in two patients correlated with contemporaneous computed tomographic scans and may allow noninvasive monitoring of therapeutic response and completeness of surgical excision. Primary and recurrent abdominal tumors, and visceral, osseous, and marrow deposits were demonstrated using this technique.
Young, fully expanded leaves from 7-month-old P-deficient citrus rootstock seedlings had levels of nonprotein arginine that were 10- to 50-fold greater than those from P-sufficient control plants. Arginine content of the protein fraction increased 2- to 4-fold in P-deficient leaves. Total arginine content, which averaged 72 +/- 6 micromoles per gram dry weight of P-sufficient leaf tissue (mean +/- se, n = the four rootstocks) was 207, 308, 241, and 178 micromoles in P-deficient leaves from Citrus limon cv rough lemon, Poncirus trifoliata x C. sinensis cv Carrizo citrange and cv Troyer citrange, and P. trifoliata cv Australian trifoliate orange, respectively. For each rootstock, the accumulation of arginine paralleled an increase in the activity of the pathway for the de novo biosynthesis of arginine. The ratio of the nanomoles NaH(14)CO(3) incorporated into the combined pool of arginine plus urea per gram fresh weight intact leaf tissue during a 3-hour labeling period for P-deficient to P-sufficient plants was 91:34, 49:11, 35:11, and 52:41, respectively. When P-deficient plants were supplied with P, incorporation of NaH(14)CO(3) into arginine plus urea was reduced to the level observed for the P-sufficient control plants of the same age and arginine ceased to accumulate. Arginase and arginine decarboxylase activity were either unaffected or slightly increased during phosphorus deficiency. Taken together, these results provide strong evidence that arginine accumulation during phosphorus deficiency is due to increased activity of the de novo arginine biosynthetic pathway.
In the first part of the study we examined silicone rubber left ventricular casts of children and adolescents by cross-sectional echocardiography using the so-called two-chamber and four-chamber apical views. Left ventricular volumes calculated from the echocardiographic left ventricular silhouettes correlated very well (r = 0.99) with the titrated cast volumes. In the second part of the study we compared in 30 infants, children, and adolescents left ventricular volumes as calculated from the two-chamber and four-chamber apical echocardiographic views with those obtained from the frontal projection of the left ventricular cineangiogram. Volumes calculated from the apical four-chamber view showed an acceptable correlation with those determined by angiography (r = 0.96 for enddiastolic and r = 0.90 for endsystolic volume). Underestimation of left ventricular enddiastolic volume by echocardiography was corrected by a factor of 1.33; no correction factor was necessary for the endsystolic volume. The correlation between the endsystolic volumes obtained by echocardiographic two-chamber view and by cineangiography was poor. Finally, in 51 infants, children, and adolescents without heart disease we determined left ventricular volumes and derived variables by cross-sectional echocardiography, using the previously established correction factor for the calculation of enddiastolic volumes. Both enddiastolic and endsystolic volumes were found to correlate linearly to body surface area.
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Raynaud's disease occurs in different clinical forms, which are not specific to the vascular spasm which characterizes the disease. This spasm virtually always develops in the same manner. Clinical aspects depend on the underlying pathology, which will define treatment. Therapeutic efficacy in Raynaud's disease is discussed. Current interest focuses on serotonin antagonists.